Competent, caring,

knowledge-based

nursing for the

people of Saskatchewa

n.

Mission: The CNA Codeof Ethics for Registered

Nurses

Linda Muzio, RNSRNA

Nursing Practice Advisor

What is the Code of Ethics?

• 1954 CNA adopted the International Council of Nurses code

• 1980 CNA developed and adopted its own Code-CNA Code of Ethics: An Ethical Basis for Nursing in Canada

• Updated every 5-6 years• Most recent version launched June

2008 CNA Convention

Nature of Ethics

• Ethics is not a black & white subject

• Ethics is not something you either know or don’t know

• Ethics involves thinking and feeling, study and practice, knowledge and intuition

Purpose of the Code • Serves as a foundation of ethical practice• Sets out expectations for ethical behavior

of RNs• Provides guidance for decision-making

– used in conjunction with professional regulations, competencies, standards & laws

• Basis from which RNs can advocate• Provides a means for self-evaluation and

self-reflection• Provides a basis for feedback and peer

review

Purpose of the Code (cont’d)• Delineates what RNs must know about

their ethical responsibilities• Informs other health care professionals

& members of the public about the ethical commitments of RNs

• Upholds the responsibility of being a self-regulating profession

• Serves as an ethical basis from which to advocate for quality practice environments

The Code Does Not…

• Provide rules of ethical or moral behavior for every circumstance

• Offer guidance about which values should take priority or how they can be balanced in practice

• Supersede other and stronger moral or legal obligations (e.g. the law)

Elements of an ethical practice

• Commitment to do good• Sensitivity and receptiveness to

ethical matters • Willingness to enter into

relationships with clients receiving care

Level of Application

• Nursing practice involves attention to ethics at various levels:– The client (individual, family,

groups, populations)– Organizational - the health care

agency or program– The community– Society– Internationally

Structure of the Code

• The Code is organized in two parts: – Part 1 – “Nursing Values and Ethical

Responsibilities” – Part 2 – “Ethical Endeavours”

Nursing Values

• Providing safe, compassionate, competent and ethical care

• Promoting health and well-being

• Promoting and respecting informed decision-making

• Preserving dignity

• Maintaining privacy and confidentiality

• Promoting justice• Being accountable

Further Support

Responsibility Statements• Each value is followed with a

number of responsibility statements• Assist in clarifying and elaborating

on the application of each value• Provide further support in assessing

the ethical situation

When Do Values Collide?

• When one’s personal, professional or institutional values conflict

• When an individual’s values conflict with the values of another individual

Types of Ethical Situations

• Ethical Problems• Ethical (or

Moral) Uncertainty

• Ethical Dilemmas or Questions

• Ethical (or Moral) Distress

• Ethical (or moral) Residue

• Ethical (or Moral) Disengagement

• Ethical Violations• Ethical (or Moral)

Courage

Moral Residue

• “Is what nurses experience when they seriously compromise themselves or allow themselves to be compromised. The moral residue that nurses carry forward from these kinds of situations can help them reflect on what they would do differently in similar situations in the future” (CNA, 2008, p. 7).

Ethical Disengagement

• “Can occur if nurses begins to see the disregard of their ethical commitments as normal. A nurse may then become apathetic or disengage to the point of being unkind, non-compassionate or even cruel to other health-care workers and persons receiving care” (CNA, 2008, p. 7).

Ethical Courage

• “Is exercised when a nurse stands firm on a point of moral principle or a particular decision about something in the face of overwhelming fear or threat to himself or herself” (CNA, 2008, p. 7).

Barriers

• Barriers to carrying out or completing the action:– Fear or circumstances beyond the RNs

control– Co-worker’s attitudes– Institutional obstacles

Sources of Moral Distress

• Harm to patients (pain, suffering)• Health policy constraints• Medical prolongation of dying

without informed choice• Inadequate staffing• Effects of cost containment

Signs of ethical & moral distress

• Anger• Frustration• Anxiety• Feeling

ashamed• Embarrassed• Heartsick• Grieving• Depression

• Miserable• Physical Pain• Sadness• Ineffective• Fatigue• Burnout• Cynicism

Symptoms Over Time

• Crying• Loss of sleep• Loss of appetite• Nightmares

• Feelings of worthlessness

• Loss of confidence• More intense or

prolonged physical symptoms

Strategies to reduce ethical distress

• Recognition• Speak Out• Education • Support• Consultation• Debriefing/case studies• Be proactive!

Summary: Ethical Distress

• Nurse perceives a moral problem• Acknowledges moral responsibility• Makes a moral judgement about

right action• Real or perceived constraints block

the action Nurse participates in perceived

moral wrongdoing - moral distress experienced

Guidance in Making MoralDecisions

• Recognize the moral dimension• Who are the interested parties?

What are their relationships?• What values are involved?• Weigh the benefits and burdens

Guide to MoralDecision-Making

• Look for similar cases• Discuss with relevant others• Does this decision accord with legal

and organizational rules?• Am I comfortable with this

decision?

Part 2: Ethical Endeavours

• RNs should advocate for and work toward eliminating social inequities. Such as:– Utilize principles of primary health

care– Address organizational, social,

economic and political factors– Advocate for change to unethical

policies/laws/regulations

The Code as a Resource

• While the code cannot enforce responsibilities outside of nursing, it can provide a powerful political instrument for nurses when they are concerned about being able to practice ethically.